Rescuers in Turkey pulled more people from the rubble early on Saturday, five days after the country's most devastating earthquake since 1939, but hopes were fading in Turkey and Syria that many more survivors would be found.
In Kahramanmaras, close to the quake's epicentre in southeastern Turkey, there were fewer visible rescue operations amid the smashed concrete mounds of fallen houses and apartment blocks, while ever more trucks rumbled through the streets shipping out debris.
The growing death toll, exceeding 24,150 across southern Turkey and northwest Syria, raised questions over Turkey's earthquake planning and response time, and President Tayyip Erdogan said on Friday that authorities should have reacted faster.
In the rebel enclave of northwest Syria that suffered the country's worst damage from the earthquake but where relief efforts are complicated by the more than decade-old civil war, very little aid had entered even after the Damascus government said on Friday it would allow convoys to cross frontlines.
In Turkey, 67 people had been clawed from the rubble in the previous 24 hours, Turkish Vice President Fuat Oktay told reporters overnight, in efforts that drew in 31,000 rescuers across the affected region.
About 80,000 people were being treated in hospital, while 1.05 million left homeless by the quakes were in temporary shelters, he added.
Few rescue efforts now result in success. In Antakya, rescue workers pulled 13 year-old Arda Can Ovun from the ruins of a building after 128 hours, wrapping him in foil and bracing his neck as he was lifted free from the ground on a stretcher.
Overnight, a 70 year-old woman and a nine year-old boy were rescued in Kahramanmaras and a 55 year-old woman was pulled from the rubble in the eastern city of Diyarbakir. However, a woman who was rescued on Friday in Kirikhan in Turkey died in hospital on Saturday.
Across the devastated region, people were still awaiting news of missing loved ones. Soner Zamir and Sevde Nur Zamir were squatting on Saturday in front of a mangled building where his parents and grandparents lived.
"Some people came out yesterday but now there is no hope. This building is too shattered for life," Zamir said.
South of the city, a convoy of six white vans with sirens and green lights marked "Funeral Transport Service" had slowly traversed the rural roads late on Friday. In one village, Hasan Kunduru said least nine bodies had been found.
"There have been no rescuers. We are doing this alone with our own hands," he said.
The disaster hit as Erdogan prepares for national elections scheduled to be held by June, and at a time when his popularity was already eroding amid the soaring cost of living and a slumping Turkish currency.
Simmering anger over the delays in aid delivery and in the launch of rescue efforts is likely to play into the election.
Even before the quake, the vote was seen as Erdogan's toughest challenge in two decades in power. Since the disaster he has called for solidarity and condemned what he called "negative campaigns for political interest".
People in the quake zone and opposition politicians have accused the government of a slow and inadequate relief early on and critics have said the army, which played a main role after a 1999 earthquake, was not involved fast enough.
Erdogan has acknowledged some problems with Turkey's initial response to the earthquake, notably transport access, but said the situation was subsequently brought under control.
"The earthquake was huge, but what was much bigger than the earthquake was the lack of coordination, lack of planning and incompetence," said Kemal Kilicdaroglu, head of the main opposition party.
Questions are also starting to be asked about the soundness of buildings in the quake-hit zone.
State prosecutors in Kahramanmaras said they will investigate the collapse of buildings and any irregularities in their construction. Police detained a contractor who built a 12-storey upmarket apartment block that collapsed in Hatay, as he waited to board a plane in Istanbul.
Monday's 7.8 magnitude quake, with several powerful aftershocks across Turkey and Syria, ranks as the world's seventh-deadliest natural disaster this century, exceeding Japan's 2011 tremor and tsunami, and approaching the 31,000 killed by a quake in neighbouring Iran in 2003.
A similarly powerful earthquake in northwest Turkey in 1999 killed more than 17,000 killed in 1999. Monday's earthquake, with a death toll so far of 20,665 people inside Turkey, is the country's deadliest since 1939.
In Syria, people waiting for news of family members buried under collapsed buildings stood solemnly by mounds of crushed concrete and twisted metal.
Many residents of rebel-held northwest Syria had already been displaced from other parts of the country that were taken back by pro-government forces during the ongoing civil war but are now being made homeless again.
"On the first day we slept in the streets. The second day we slept in our cars. Then we slept in other people's homes," said Ramadan Sleiman, 28, whose family had fled eastern Syria to the town of Jandaris, which was badly damaged in the quake.
Syrian President Bashar al-Assad made his first reported trip to affected areas since the quake, visiting hospitals in Aleppo on Friday and Latakia on Saturday, state media said, after approving deliveries of aid across frontlines of the civil war.
Dozens of planeloads of aid have arrived in areas held by Assad's government since Monday but little has reached the northwest, the worst-affected area. In normal times, U.N. delivers aid to the region across the border with Turkey via a single checkpoint, a policy that Damascus criticises as violating its sovereignty.